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Client Information Form

Step 1 of 4

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Personal Details
Name(Required)
DD slash MM slash YYYY
Do you smoke?

Employment Details
Employment Type

Estate Planning
Do you have a Will?
Do you have a Power of Attorney?
Do these need updating?
Personal Insurances
Do you have life/TPD cover? (including in superannuation)
Do you have Income Protection cover? (including in superannuation)
Do you have trauma (critical illness) cover?
Have you had your insurance needs recently reviewed (within 2 yrs) to protect you and your family from death, disablement, injury or illness?
Do you have a partner?(Required)
Your partner's details
Name
DD slash MM slash YYYY
Do you smoke?

Employment Details
Employment Type

Estate Planning
Do you have a Will?
Do you have a Power of Attorney?
Do these need updating?
Personal Insurances
Do you have life/TPD cover? (including in superannuation)
Do you have trauma (critical illness) cover?
Do you have Income Protection cover? (including in superannuation
Have you had your insurance needs recently reviewed (within 2 yrs) to protect you and your family from death, disablement, injury or illness?
Children and/or Financial Dependents
Name
D.O.B
 
Your objectives and/or comments
 
Financial Details
Assets
Assets
Description
Owner
Value($)
 
Please include all properties, cars, boats, caravans, cash, shares, businesses and other assets.
Debts
Debt
Description
Owner
Value($)
 
Please include loans for all homes, land, investment, business, personal, credit cards and other loans.
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Financial Services Guide

Schembri Wealth Pty Ltd ABN 61 158 801 355 ATF The Schembri Family Trust ABN 32 235 422 764 t/a MLS Financial is a Corporate Authorised Representative (No. 001258535) of Infocus Securities Australia Pty Ltd ABN 47 097 797 049 AFSL No. 236523 trading as Infocus Financial Advice and Infocus Money Management. Head Office: PO Box 1856 Sunshine Plaza QLD 4558 Phone: 1300 784 448

Disclaimer: The information contained on this website is of a general nature only and neither represents nor is intended to be specific advice on any particular matter. MLS Financial and Infocus Securities Australia Pty Ltd strongly suggests that no person should act specifically on the basis of the information contained herein but should seek appropriate professional advice based upon their own personal circumstances.

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